Bariatric Surgery:

Bariatric Surgery is the broad term for a range of weight loss surgeries designed to overcome obesity. Obesity is a body weight condition that can negatively affect overall health and potentially contribute to other conditions such as diabetes, sleep apnea and heart disease. There are typically 2 categories of weight loss surgeries: Restriction and Malabsorption. Restriction limits the amount of food that a patient is able to eat. Malabsorption reduces the number of calories that the body absorbs. Restrictive procedures include Gastric Sleeve and Gastric Banding. Gastric Bypass and Duodenal Switch are procedures that are both restrictive and malabsorptive.

Gastric Sleeve:

This is a restrictive procedure where the surgeon removes 75-80% of the stomach which creates a “new” stomach that is smaller and tube-shaped. Because the smaller stomach holds less food, patients feel fuller from less calories. It has also been shown to change the body’s hunger hormones in patients.

Gastric Banding:

This is a restrictive procedure where the surgeon places a “Band” around the stomach to restrict the amount of food that the patient can ingest, therefore making them feel fuller with a smaller amount of food. This band is adjustable as each situation is different. It can also be removed in the future if needed.

Gastric Bypass:

This procedure is both restrictive and malabsorptive, so it limits the amount of food a patient can eat and it actually changes how the food is digested. Most surgeons typically perform gastric bypass laparoscopically, which means that only tiny incisions are made in order to access the organs. The stomach is reduced to a fraction of its original size and part of the intestine is bypassed.

Duodenal Switch:

Some surgeons reserve this surgery for patients that have a body mass index over 50. This is a restrictive and malabsorptive procedure in which the surgeon takes out roughly 75% of the stomach. Then the digestive system is adjusted to decrease calorie absorption.

Pain Pumps (or Intrathecal Pump)

A pain pump is a therapy that delivers medication directly to your spinal cord. The system uses a small “pump” that is surgically placed under the skin of your abdomen. The pump delivers medication through a catheter to the area around your spinal cord. Because the drug is delivered directly to the pain area, your symptoms can be controlled with a much smaller dose than is needed with oral medication. Thus reducing the side effects of medication.

There is a space around your spinal cord that is filled with fluid called the the intrathecal space. Cerebrospinal fluid (CSF) flows through this area, bathing and protecting your brain and spinal cord. An pain pump works better than medications taken orally because it delivers medicine directly into the CSF, therefore bypassing the path that oral medication takes through your body. It takes only about 1/300 the amount of medication with a pump than when taken orally.

The pump is a round metal device about the size of a hockey puck that is surgically implanted beneath the skin of your abdomen. A small plastic tube, called a catheter, is surgically placed in the intrathecal space of the spine and is connected to the pump. A space inside the pump called the reservoir holds the medication

The pump is programmed to slowly release medication over a period of time. The pump stores the information about your prescription in its memory, and your doctor can easily review this information with the programmer. When the reservoir is empty, the doctor or nurse refills the pump by inserting a needle through your skin and into the fill port on top of the reservoir.

This therapy is completely reversible if you should ever decide to have the pump removed.

Determining whether a pain pump will be a good option for you is a complex process. Before a permanent pump can be implanted, you must undergo a trial to see if the device decreases your level of pain. Depending on your particular condition, one of the following screening tests will be necessary:

1: Single injection: you will receive one injection of intrathecal medicine (morphine or baclofen) through a lumbar puncture.

2: Multiple injections: you are given multiple injections over a series of days by either a lumbar puncture or catheter.

3: Continuous trial: a catheter is placed in the correct area of your spine and connected to an external pump. The dose is increased every 2 hours until you notice pain relief.

During the trial, the doctor gathers information about the best location for the catheter and the type and amount of drug that works best for you. If the trial is successful, you will be scheduled for surgery. Prior to surgery you may be scheduled for presurgical tests (e.g., blood test, electrocardiogram, chest X-ray) several days before surgery. Patients are typically admitted to the hospital the morning of the procedure. No food or drink is permitted past midnight the night before surgery. An IV line is started. An anesthesiologist will explain the effects of anesthesia and its risks.

There are two parts to the procedure: 1) placement of the catheter in the intrathecal space surrounding the spinal cord, and 2) placement of the pump/reservoir in the abdomen. The operation can take approximately 2 hours for the surgery.  There will be discomfort as you recover from the procedure. Your doctor will give you post-op wound care and restriction instructions.